197601800-6-22-2021-29-AS-DPEA-CHBNBY-20220815101955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197601800
Report Date: 06/22/2021
Date Signed: 06/22/2021 03:19:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2021 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20210415084328

FACILITY NAME:	MEDAL RESIDENTIAL BOARDING & CARE		FACILITY NUMBER:	197601800
ADMINISTRATOR:	BELLA MEDALLA		FACILITY TYPE:	740
ADDRESS:	12952 ELKWOOD STREET		TELEPHONE:	(818) 503-3980
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 0	DATE:	06/22/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Bella Medalla - Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff yelled at resident
Facility staff locked residents in the facility
Facility staff do not allow residents to attend religious services
Facility staff are financially abusing resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Brian Balisi and Martha Guzman-Chavez initiated a subsequent complaint investigation for the allegations listed above. At 1:00pm LPAs met with Bella Medalla, the facility administrator and explained the reason for the visit.

During the course of the investigation, LPA conducted a physical plant tour virtually on 04/16/2021 as well as interviewed Administrator. On 6/3/21 LPAs conducted interviews with facility staff and gathered and reviewed facility documentation pertinent to the allegation. Today LPAs conducted interviews with the Assistant Administrator and reviewed additional documents.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210415084328

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MEDAL RESIDENTIAL BOARDING & CARE	FACILITY NUMBER: 197601800
	VISIT DATE: 06/22/2021

NARRATIVE

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Continued from 9099

In regards to the allegations that Facility staff yelled at resident, facility staff locked residents in the facility , facility staff do not allow residents to attend religious services and facility staff are financially abusing resident, LPAs record review , physical plant observations and interviews with facility staff and health care service providers revealed there was insufficient evidence to prove the above allegations occurred. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that Facility staff yelled at resident, facility staff locked residents in the facility , facility staff do not allow residents to attend religious services and facility staff are financially abusing resident Therefore the above allegations are UNSUBSTANTIATED at this time.

Exit interview was conducted with Administrator, and report issued was sent via E-mail.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC9099 (FAS) - (06/04)

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